1508065145 NPI number — VEERAVAT TAECHARVONGPHAIROJ M.D.

Table of content: VEERAVAT TAECHARVONGPHAIROJ M.D. (NPI 1508065145)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508065145 NPI number — VEERAVAT TAECHARVONGPHAIROJ M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TAECHARVONGPHAIROJ
Provider First Name:
VEERAVAT
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508065145
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/24/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1545 W FLORIDA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HEMET
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92543-3814
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-791-1111
Provider Business Mailing Address Fax Number:
888-856-3893

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
850 E LATHAM AVE STE 205
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HEMET
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92543-4391
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-658-7205
Provider Business Practice Location Address Fax Number:
888-696-1501
Provider Enumeration Date:
07/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  A115763 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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